chronic disease prevention november 20, 2008. objectives background: setting the stage status of...
TRANSCRIPT
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Chronic Disease Prevention
November 20, 2008
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Objectives
Background: Setting the Stage
Status of Chronic Diseases in San Diego
Evidenced-based Best Practices
HHSA Chronic Disease Prevention Model
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Setting the Stage
Why Chronic Disease?
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Why Chronic Disease?Why Chronic Disease?• California Conference for Local
Public Health Officers (CCHLO)– Chronic Disease Conference– Spurred Idea to develop CC Agency for
Agency • Two meeting held to date to develop an
inventory of Agency Chronic Disease activities
– SPOS came to PHS to conduct a “Focused Dialogue”
– Chronic Disease was chosen
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What Is Chronic Disease?What Is Chronic Disease?
• According the U.S. National Center for Health Statistics, is a disease that lasts 3 months or more.
• Cannot be prevented by vaccines or cured by medications.
• Caused by health damaging behaviors - particularly tobacco use, lack of physical activity, and poor eating habits.
• Is the leading cause of death and disability in the United States.
• Accounts for 7 of the 10 U.S. leading cause of death.
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Why Should We Care?
• Chronic diseases are prevalent, preventable and costly!
• Cause extended pain and suffering, associated with decreased quality of life for millions.
• Treatment for seven chronic diseases including cancers, mental illnesses, heart disease, lung conditions, hypertension, stroke, and diabetes ran to nearly $280 billion in 2003; now estimated to be to $1.3 trillion per year.
• Prevention programs are highly cost-effective
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Top 10 Causes of Mortality in San Diego County
Rate
Rank 2004
Rank 2005
Cause of Death 2004 2005
1 1 Heart Disease 183.7 172.6
2 2 Cancer (any) 166.3 163.1
3 3 Stroke 49.8 41.3
4 5COPD/Chronic lower respiratory diseases
38.3 39.1
5 4 Alzheimer's Disease 38.1 36
6 6 Unintentional injuries 28.6 28.5
7 7 Diabetes mellitus 19.1 21.1
8 8 Influenza & pneumonia 16.6 14.3
9 9 Suicide 10.4 9.9
10 10Essential (primary) hypertension and hypertensive renal disease
9.1 9.4
Rates are per 100,000 population. Source: State of California, Department of Public Health, Center for Health Statistics, Vital Statistics Section, Death Statistical Master Files
= Chronic Diseases
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Death by Risk Factors
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Physical Activity by Gender
Per
cen
t
WomenNutrition by Gender
0
20
40
60
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Men
Women
Men
PA and Nutrition Trends
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Healthcare Cost in California and San Diego
• $130 Billion spent (treatment and lost productivity) by California in 2003
• $4.3 Billion in SD County (not including lung cancer treatment)
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3 – FOUR – 503 RISK FACTORS
(Tobacco Use, Poor Diet, Lack of Physical Activity)
4 CHRONIC DISEASES(Heart Disease/Stroke, Type 2 Diabetes, Respiratory Disease, Cancer)
50% of DEATH
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Status of Chronic Diseases
in San Diego
What Are the Statistics?
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*2006 U.S. data are preliminary
Life Expectancy at Birth: San Diego vs. U.S. Population, 2000-2006*
80.6 80.580.7 80.7
80.580.7
77.077.2 77.3 77.4
77.8 77.878.1
80.8
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
2000 2001 2002 2003 2004 2005 2006*
Year
Age
San Diego U.S.
LIFE EXPECTANCY TRENDSSan Diego County vs United States, 2000-2006
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San Diego County PopulationSan Diego County Populationby Race/Ethnicity, 2007by Race/Ethnicity, 2007
Source: SANDAG, San Diego County 2007 Population Estimates
• 3 million people
• Racial/Ethnic groups from around the world.
• Over 100 languages
Asian 9.4%N=292,251
White 51.6%N=1,597,847
Black 5.4%N=166,486
Hispanic 29.3%N=906,898
Hawaiian/Pacific Islander 0.4%N=13,144American Indian
0.5 %N=15,946
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San Diego County PopulationSan Diego County Populationby Race/Ethnicity, Census 1990 vs. 2000 vs. 2007by Race/Ethnicity, Census 1990 vs. 2000 vs. 2007
0
10
20
30
40
50
60
70
Hispanic White Black AmericanIndian
Asian
1990 2000 2006
Source: SANDAG, San Diego County 1990, 2000 Census, and 2007 Population estimates
Between 1990 & 2000:
• The population of Hispanics and Asian increased
• The population of Whites and Blacks decreased
Percent
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105.7
145.4173.5
216.6
0
50
100
150
200
250
300
White Black Hispanic Asian/Other
Race/Ethnicity
Rat
e p
er 1
00,0
00
All Cancer DeathsAll Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
Cancer is the
second leading
cause of death
for San Diego
County
San Diego County Overall Rate, 2005: 163.1 / 100,000
HP 2010 Goal: 159.9
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Selected Cancer DeathsSelected Cancer Deathsby Race/Ethnicity, 2005by Race/Ethnicity, 2005
0
10
20
30
40
50
Lung F. Breast Prostate Colorectal
Race/Ethnicity
Rat
e p
er 1
00,0
00
White Black Hispanic Asian/Other
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
HP 2010 Goal
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Coronary Heart Disease and Stroke Deathsby Race/Ethnicity, 2005
0
50
100
150
200
250
300
White Black Hispanic Asian/Other
Race/Ethnicity
Rat
e p
er 1
00,0
00
CHD Stroke
Note: All rates are adjusted to 2000 Standard U.S. Population.Source: California Death Statistical Master File; SANDAG January 1, Population Estimates.
Blacks have the highest rate of coronary heart disease deaths and stroke
deaths compared toother racial and ethnic groups.
HP 2010 Goal CHD: 166.0
HP 2010 Goal Stroke: 48.0
San Diego County Overall: CHD Rate - 128.4 / 100,000 Stroke Rate – 41.3 / 100,000
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Diabetes Diabetes by Race/Ethnicityby Race/Ethnicity
Source: Youth Risk Behavior Survey (YRBS), San Diego City Schools; California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates; California Health Interview Survey (CHIS), California Department of Health Services, Death Statistical Master File.
R/E
HospitalAdmissions
2005
Deaths (underlyin
g)2005BlackWhite
HispanicAsian/Other
69.016.633.521.2
303.587.1236.087.6
10.77.7
18.47.4
% High School
Students Overweigh
t 2005
Prevalence of Diabetes
Among Adults 2005*
6.65.16.57.2
* - Percentage of adults who were ever diagnosed with diabetes
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Diabetes Mortality
Among the top 53 U.S. City/County jurisdictions
San Diego County:
• Ranked 52 in 1990
• Ranked 46 in 2004
• Ranked 8th in the highest rate of change between 1990 and 2004
Source: NACCHO 53 Big Cities Health Inventory, 2007
Note: Ranking scheme - 1 being worst and 53 being best
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Diabetes Mortality Among San Diego County Residents, 2000-2005
481 491 475499
531
60419.2 19.3
18.3 18.6 19.1
21.1
0
100
200
300
400
500
600
700
800
2000 2001 2002 2003 2004 2005
Dea
ths
0
5
10
15
20
25
Rat
e pe
r 10
0,00
0
Deaths Rate
Deaths and Age-adjusted Rates
HP2010= 45
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Diabetes Hospitalizations Among San Diego County Residents, 2001-2005
28833041 3166 3244
3406108.1 111.8 112.9 113.8
118.1
0
1000
2000
3000
4000
5000
2001 2002 2003 2004 2005
Hos
pita
liza
tion
s
0
50
100
150
Rat
e pe
r 10
0,00
0
Hospitalizations Rate
Number and Age-adjusted Rates
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Diabetes Hospitalizations Among San Diego County Residents, 2001-2005
276.7 283.4
327.7
274.6303.5
207.7 212.9 212224.6 236
87.7 88 87.5 88 87.173.1 75.3 78.1 75.4
87.6
0
100
200
300
400
2001 2002 2003 2004 2005
Rat
e pe
r 10
0,00
0
Black Hispanic White Asian/Other
By Race/EthnicityNumber and Age-adjusted Rates
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Overweight & Obese Adults* Overweight & Obese Adults* by Race/Ethnicity, 2005by Race/Ethnicity, 2005
16.126.5 26.9
9.8
37.530.4 35.3
33.5
0
25
50
75
100
White Black Hispanic Asian
Race/Ethnicity
Per
cen
tag
e (%
)
Obese (BMI >30) Overweight (BMI 25-30)
* as Defined by Body Mass Index (BMI)* as Defined by Body Mass Index (BMI)Source: 2005 California Health Interview Survey (CHIS)
HP 2010 Goal
Obesity (BMI >30):
15%
Unhealthy weight (BMI>25): 40%
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Asthma in San Diego CountyAsthma in San Diego Countyby Race/Ethnicityby Race/Ethnicity
Source: 2005 California Health Interview Survey (CHIS), California Office of Statewide Planning and Development;SANDAG January 1, Population Estimates. California Department of Health Services, Death Statistical Master File
* - These results for Blacks reflect 2003 data results since sample size for Blacks in 2005 was statistically unreliable.
Race/Ethnicity
Hospitalization Rate, 2005
Average Annual Number
of Deaths2002-2004
BlackWhite
HispanicAsian/Other
318 3 4
204.759.374.962.6
Estimated Prevalenc
eAmong
Children 200513.8*
9.612.411.7
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Selected Health Indicators*San Diego County, CA, & US, HP2010
Indicator
• Infant Mortality• Adults reporting poor/fair health• Incidence of AIDS• CHD Deaths• Suicides• F. Breast Cancer Deaths• Unintentional Injury Deaths
San Diego
County CA U.S.
Healthy People 2010 Goal
4.614.4%14.0
144.410.522.928.8
5.316.0%11.8
162.88.5
24.130.5
7.014.0%15.0
159.610.726.037.7
4.5None1.0
166.05.0
22.3
* - These data reflect the most current comparable data
The numbers above reflect either rates or percentages
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Evidence-based Best
Practices
Do They Work?
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Direction from the National Level
• Federal Government Agencies
– United States Department of Agriculture
– United States Surgeon General
– Centers for Disease Control
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“Healthy places are those designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders -- where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options.”
CDC’s “Designing & Building Healthy Places”
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• Leading Public Health Organizations– National Association of County and City Health Officials– National Task Force on Community Preventive
Services– Robert Wood Johnson Foundation – Kaiser Permanente– American Planning Association (funded by CDC)
Direction from the National Level
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• Public– California Conference of Local Health
Officers– California Department of Public Health– Governor's Obesity Prevention Plan
• Private– The California Endowment– Strategic Alliance
Direction from the State Level
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Best Practices and Promising Interventions
1. Healthy Community Improvements
2. Healthy Community Development
3. Healthy Community Plans & Policies
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1. Healthy Community Improvements
Partnering with communities and cities to improve existing physical and social conditions that prevent physical activity and healthy eating
Best Practices and Promising Interventions
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Healthy Community Improvements
• Safe and healthy routes to schools, parks, healthy foods, seniors– Traffic calming, improve street
crossings
• Installing/improving sidewalks & bike paths
• Community gardens
• School/community joint use agreements
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Safe and Healthy Routes to Schools and Parks, Healthy Foods, Seniors
AARP
- assessments
- advocates
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From abandoned lots to community gardens…
Create gardens for culturally appropriate foods reflective of the community.
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CX3 Projects (Chula Vista & La Mesa)Communities of Excellence in Nutrition, Physical Activity and Obesity
Prevention
• Strong Partnerships• Leadership Training• Youth &
Mentors
• Community Assessment• Advocacy
OutcomesLa Mesa Chula Vista
$550,000 Safe Routes to School grant to improve sidewalk connectivity
Community “reclaimed” Lauderbach Park
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2. Healthy Community Development
Promoting healthy development and redevelopment projects in neighborhoods
Best Practices and Promising Interventions
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Healthy Community Development
• Integrating “Healthy Places” design into the Development Review process
• Redevelopment areas
• Grocery stores in underserved areas
• Facility design
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Helping Communities get Developments Designed for “Health”
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Trails and Trail Access Points
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Eliminating Food Deserts… Attracting a Grocery Store into East Oakland, CA
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Partners: East Oakland Diabetes Work Group, Alameda County Department of Public Health, Network for a Healthy California
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3. Healthy Community Plans & Policies
Promoting healthy government, school and worksite policies and plans that support physical activity, healthy eating and tobacco-free environments
Best Practices and Promising Interventions
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Healthy Community Plans & Policies
• Land use & transportation planning
• Affordable housing policies
• Regional Food Systems & Urban Agriculture
• Worksite Wellness policies
• Government Wellness policies
• School Wellness policies
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City of Richmond General Plan Update
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City of Richmond Health and Wellness Element
Policy Framework
www.healthycommunitiesbydesign.org
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School Wellness Gardens
Classroom Garden Beds Quad Area with Gardening
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Healthier Vending Machines
→
→
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Chronic Diease Model
Will it Work?
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Individuals Families
Neighborhoods
Policies and
Laws
Socio-Ecological Model
Businesses
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Environmental Approaches to Tobacco: The California Model
• Prop. 99 Tobacco Tax Funds
• Local Ordinances and State Legislation for Smoke-Free Environments
• Massive Anti-Tobacco Campaign
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California vs. The US
• Smoking Rates
• Lung Cancer Death Rates
Pe
rce
nt
American Lung Association of California
Centers for Disease Control, National Cancer Institute, statecancerprofiles.cancer.gov
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Tobacco and Heart Attacks• Pueblo, Colorado
– Decrease in heart attack rates by 28% after smoke-free ordinance
• 399 HA pts in 1.5 yrs prior to ordinance, only 291 HA pts in 1.5 yrs after
• Helena, Montana– Decrease in heart attack rates by 40% during
first 6 months of smoke-free ordinance
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Why Act Now?
Chronic Disease Prevention is strategic:
– Fundamental to reducing death and disability and improving community health
– Critical to cutting health care costs
– Experience to-date shows that strategies can be very cost-effective
– Funding opportunities for strategies that focus on environmental change
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At its Foundation…
Place Matters
Adopting the concept that neighborhood environmental
factors all affect individual behaviors and health
From Policy Link and
The California Endowment
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Why Place Matters: Environmental Strategies
• Physical Environment– Safe parks; full-service grocery stores
and farmers’ markets; safe, walkable streets; less truck and bus traffic; well-maintained housing; open spaces.
• Social Environment– Strong social networks that bring
neighbors together—whether to advocate for change, cultivate a community garden, or provide services.
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Why Place Matters: Environmental Strategies
• Economic Environment– Commercial investment, jobs that take
people out of poverty, businesses that provide healthy food options.
• Service Environment– Access to quality healthcare services,
public safety, and community support services.
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Understanding the problem
Heart Disease/StrokeType 2 Diabetes
CancerRespiratory Disease
Poor environments Unhealthy behaviors Chronic Diseases
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Adopting a new solution
Healthy environments Healthy Behaviors Disease Reduction
Reduction in:Heart Disease/Stroke
Type 2 DiabetesCancer
Respiratory Disease
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QA & Comments